Week 11 ICP Flashcards
What is normal ICP?
<15 mm Hg
risk of ischemia and infarction occurs at what measurment of ICP?
> 20 mm Hg
What are the 3 components that try to compensate for increased ICP?
- brain tissue (distention of dura, compression of tissue)
- Blood (vasoconstriction)
- Cerebrospinal fluid (make less, displace down spinal column)
What is normal CPP?
70-100 mm Hg
What CPP is neccessary for adequate perfusion?
50-60 mm Hg
What CPP is incompatibe with life?
<30 mm Hg
how do we determine CPP?
MAP- ICP= CPP
How do we increase CPP?
decrease ICP
or
increase MAP
What is hypercarbia?
Increased PaCO2 causes dilation of cerebral vessels which can increase ICP
What is Hypocarbia?
Decreased PaC02 causes vasoconstriction of cerebral vessels which can decrease perfusion
What is Hypoxemia?
damages brain tissue and causes dilation of cerebral vessels which can increase ICP
What do nurses monitor to avoid ICP increase?
BP
O2
CO2
What do nurses want to prevent, primary or secondary brain injury?
secondary brain injury!
How do we prevent and manage increased ICP?
- HOB elevated 30* - no sudden vertical changes
- Keep head midline - no neck flexion to squish blood vessels
- no Hip flexion
- no coughing /straining/ constipation
- O2 want >95% (ambubag before & after suction)
- Quiet environment
- DO NOT cluster care d/t stress/clenching
- VS, mouth care, etc
- monitor closely BP, HR, temp, ICP, MAP, report inadequate CPP
What is the first sign of IICP?
altered LOC
What is a late sign of IICP?
Cushings triad - then Cheyenne Stokes
What are three signs of altered LOC?
- unilateral pupil change in size, equality and/or reactivity
- altered respiratory pattern
- unilateral hemiparesis (opposite side)
What are the 3 signs of decreased LOC (stupor)?
- Unilateral or bilateral pupil changes
- cheyne- stokes
- decorticate or decerebrate posturing
What are 3 signs of coma?
- bilaterally fixed and dilated pupils
- Respiratory arrest
- absence of motor response (flaccid)
What do we do if there are changes that suggest an increase in ICP?
tell physician immediately!
What is an early indicator of decreasing LOC?
restlessness & irritability
What is cushings triad?
- BP goes up
- HR goes down
- irregular resps (cheyne stokes)
What are 4 components of neuro assessment?
- LOC
- Pupils
- VS
- Limb movement/strength
Which posture is worse, decerebrate or decorticate?
Decerebrate
External Ventriculr Drain (EVD). What, When, Why, How
what: Catheter inserted into ventrical (ventriculostomy)
When: Usually when GCS is less than 8 (coma)
Why: Used to monitor ICP and guide clinical care
How: Can also remove cerebral spinal fluid to decrease intracranial pressure
What are 3 considerations when using EVD?
- high risk of infection (prophylactic antibiotics and aspectic technique)
- Keep body position still
- transducer level with ear (use level)
What drugs are used with ICP and why?
- Osmotic diuretic - Mannitol = increase MAP (blood less thick)
- Hypertonic Saline 3% = increase Na
- Loop diuretic - Lasix = adjunct to mannitol
- Anti-seizure meds - Dilantin (phenytoin)
- Barbs/sedation - propofol if ICP very high to decrease cerebral metabolism
- Corticosteroids - antiinflammatory for brain tumour (Decadron)
- Stool softeners - Colace (docusate sodium)
- Analgesics- fentanyl
- Antibiotic - broad spectrum
- Antipyretics - Tylenol - b/c TBI = hypermetabolic=fever
How do we position a patient with high ICP in a coma and why?
side lying
prevent tongue obstructing airway
What two things must we remember when suctioning someone with high ICP?
- Abubag before and after to replace oxygen
- limit suction to 2 passes <10sec
What do we put in to relieve pressure on diaphragm for someone with high ICP?
Nasogastric
What is used to maintain airway if necessary?
intubation
mechanical ventilation
What are the 7 things we must do to care for patients with IICP?
- Maintain airway/resp
- Fluid & electrolytes balance
- Body positioning
- Nutrition therapy - needs lots of calories- hypermetabolic
- Supportive therapy
- Protect from injury
- Psychological care (patient & family)
What 3 ways do we monitor fluid and electrolyte balance?
- amount accurately (I&O) - too much can increase ICP
- Monitor electrolytes - diuretics and IV fluid can affect them
- Monitor urinary output-
-DI
- SIADH (b/c pressure on pituitary= too much antipee hormone = increase Na)
What is supportive therapy for ICP care?
Reduce metabolic demands as much as possible to prevent further increase in ICP
-Control fever to keep energy burning down ,monitor for seizures
-Manage Pain
-Decrease Stimuli
How do we protect from injury (confusion, agitation, seizures) in ICP care?
-Least restraint approach b/c it stresses the fuck out of everyone and increases ICP
-Pad side rails
-Light Sedation when appropriate
-Calm reassuring approach
How do we provide psychological care for patients and families when caring for increased ICP?
-Competent assured manner
-Short simple explanations
-Allow family participation in care when possible
